Provider Demographics
NPI:1992305361
Name:EBRAHIM, YOUSSEF
Entity type:Individual
Prefix:
First Name:YOUSSEF
Middle Name:
Last Name:EBRAHIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27723 SUMMER PLACE DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-7613
Mailing Address - Country:US
Mailing Address - Phone:937-430-7963
Mailing Address - Fax:
Practice Address - Street 1:2677 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-2512
Practice Address - Country:US
Practice Address - Phone:727-431-4914
Practice Address - Fax:727-431-3912
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL53161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist